Understanding PMDD: The Role of Hormones

3 Jul

Premenstrual Dysphoric Disorder (PMDD) is a severe condition that affects about 3-8% of women, individuals assigned female at birth (AFAB) and gender-diverse people. It is characterised by severe emotional and physical symptoms that interfere with daily life. Unlike PMS, PMDD is not merely about hormonal levels but rather about hormonal sensitivity. Those with PMDD have a heightened sensitivity to the normal fluctuations of hormones like oestrogen and progesterone that occur during the menstrual cycle. This increased sensitivity can trigger severe mood disturbances, anxiety, and depression, making it a significant mental health concern (Schmidt et al., 2017).

The Hormones Involved in PMDD

1. Oestrogen

Role in PMDD: Oestrogen is a primary sex hormone that regulates the menstrual cycle. During the follicular phase, oestrogen levels rise, peaking just before ovulation. While oestrogen is generally considered to have mood-stabilising effects, its fluctuations can contribute to PMDD symptoms.

Impact on Mood: Research suggests that individuals with PMDD may be more sensitive to changes in oestrogen levels. When oestrogen levels drop sharply after ovulation, this can trigger mood swings, irritability, and other emotional symptoms (Schmidt et al., 2017).

2. Progesterone

Role in PMDD: Progesterone levels increase after ovulation, during the luteal phase of the menstrual cycle. This hormone prepares the body for potential pregnancy by thickening the uterine lining.

Impact on Mood: In individuals with PMDD, sensitivity to progesterone and its metabolites, particularly allopregnanolone, may play a significant role. Allopregnanolone interacts with the GABA-A receptors in the brain, which are involved in mood regulation. Fluctuations in progesterone levels can lead to anxiety, depression, and irritability in susceptible individuals (Bäckström et al., 2011).

3. Serotonin

Role in PMDD: Serotonin is a neurotransmitter that helps regulate mood, sleep, and appetite. Its production and activity are influenced by oestrogen and progesterone levels.

Impact on Mood: Individuals with PMDD often exhibit altered serotonin function. Oestrogen increases serotonin levels and receptor sensitivity, while progesterone and its metabolites can decrease serotonin activity. This imbalance can contribute to the mood disturbances seen in PMDD (Rapkin et al., 2013).

4. Allopregnanolone

Role in PMDD: Allopregnanolone is a neuroactive steroid derived from progesterone. It modulates the GABA-A receptors in the brain, which have calming effects.

Impact on Mood: While allopregnanolone generally has anxiolytic properties, individuals with PMDD may have an abnormal response to this steroid. Some studies suggest that instead of producing calming effects, allopregnanolone may induce negative mood symptoms in these individuals, contributing to PMDD (Bäckström et al., 2011).

5. Cortisol

Role in PMDD: Cortisol is a stress hormone released by the adrenal glands. It helps the body respond to stress and has various effects on metabolism and immune response.

Impact on Mood: Individuals with PMDD often have an exaggerated cortisol response to stress. This heightened stress sensitivity can exacerbate PMDD symptoms, leading to increased anxiety and mood swings (Gordon et al., 2016).

Interactions Between Hormones

The interplay between these hormones is complex and significantly influences the severity of PMDD symptoms. For instance, the drop in oestrogen and rise in progesterone post-ovulation can disrupt serotonin activity, leading to mood disturbances. Additionally, the body's response to stress through cortisol secretion can further exacerbate symptoms, creating a vicious cycle of emotional and physical distress.

Treatment Approaches

1. Hormonal Therapies

Combined Oral Contraceptives: These can stabilise hormonal fluctuations and reduce PMDD symptoms by suppressing ovulation.
GnRH Agonists: These drugs create a temporary menopause-like state, eliminating menstrual cycles and associated hormonal changes.

2. Antidepressants

SSRIs and SNRIs: These medications increase serotonin levels in the brain and are effective in reducing PMDD symptoms.

3. Lifestyle Modifications

Diet and Exercise: Regular physical activity and a balanced diet can help manage stress and improve overall well-being.
Stress Reduction Techniques: Practices such as yoga, meditation, and mindfulness can help reduce stress and alleviate PMDD symptoms.

4. Therapy

Therapy can help individuals with PMDD develop coping strategies to manage emotional symptoms and reduce their impact on daily life.

Conclusion

PMDD is a multifaceted disorder influenced by complex hormonal interactions. Understanding the roles of oestrogen, progesterone, serotonin, allopregnanolone, and cortisol can help in developing effective treatment strategies. Individuals experiencing PMDD should consult healthcare professionals to explore the best approaches tailored to their specific needs, ensuring a holistic and comprehensive treatment plan.

References

Bäckström, T., Haage, D., Löfgren, M., Johansson, I. M., Strömberg, J., Nyberg, S., & Andréen, L. (2011). Neuroendocrine mechanisms and the role of neurosteroids in PMS and PMDD. Psychoneuroendocrinology, 36(1), 102-118.
Gordon, J. L., Girdler, S. S., Meltzer-Brody, S. E., Stika, C. S., & Rubinow, D. R. (2016). Hormone and HPA axis changes during the luteal phase in women with PMDD: Impact of stress. Biological Psychology, 119, 144-153.
Rapkin, A. J., Mikacich, J. A., Moatakef-Imani, B., & Rasgon, N. (2013). The role of serotonin in premenstrual syndrome. The Journal of Clinical Psychiatry, 74(10), 1038-1045.
Schmidt, P. J., Martinez, P. E., Nieman, L. K., Koziol, D. E., Thompson, K. D., Schenkel, L., & Rubinow, D. R. (2017). Premenstrual dysphoric disorder: Molecular pathophysiology and evolving therapeutic strategies. Current Psychiatry Reports, 19(9), 61.

Sarah Newbold